Bates Chapter 1 Physical Examination and History Taking
1. What are the steps of clinical reasoning
-Identifying symptoms and abnormal findings
-Linking findings to underlying pathophysiology or psychopathology
-Establishing and testing a set of explanatory hypotheses
2. What is comprehensive assessment?
- Comprehensive assessment is the elements of the health history and the complete physical examination.
3. What is Focused Assessment?
A problem oriented or a more flexible focused assessment is appropriate in many situations is important and particularly for patients you know well who are returning for routine office care or for patients with specific "urgent care" concerns like sore throat or knee pain.
4 When will you adjust the scope of the history and physical Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible examination keeping several factors in mind:
- Available time
- The magnitude and severity of the patents' problem
- The need for thoroughness
- The clinical setting- inpatient or outpatient
- Primary or subspecialty care
5. Overview of Comprehensive Assessment
- Its appropriate for new patients in the hospital or office
- It provides fundamental and personal knowledge about the patient
- It strengthens the clinician-patient relationship
- Helps identify or rule out physical causes related to patient concerns
- Provides baselines for future assessments
- Creates platform for health promotion through education and counseling
- Develops proficiency in the essential skills of physical examination
6. When is Focused Assessment appropriate?
Focused assessment is appropriate for established patients, especially during routine or urgent care visits
- Addresses focused concerns or symptoms
- Assesses symptoms restricted to a specific body system
- Applies examinations methods related to assessing the concern or problem as precisely and carefully as possible
Focused examination will select methods relevant to thorough assessment of the targeted problem- the patient's symptoms, age, and health history help determine the scope of the focused examination
7. Findings have validated the importance Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible of physical examination techniques such as:
- Blood pressure measurements
- Assessment of central venous pressure from the jugular venous pulse
- Listening to the heart for evidence of valvular disease
- Detection of hepatic and splenic enlargement
- Pelvic examination with Papanicolaou smear
8. What is subjective data?
- This is obtained from what the patient tells you
- The history, from Chief Complaint through Review of Systems
9. What is objective data?
- This is data from what you detect during the examination
- All physical examination findings
10. Outline the 7 comprehensive Adult Health History component
- Identifying Data and Source of the history; reliability
- Chief complaint(s)
- Present Illness
- Past history
- Family history
- Personal and social history
- Review of Systems
11. The narrative should include:
- The onset of the problem
- The setting in which it has developed
- Its manifestations
- Any treatment
12. Each principal symptom should be Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible characterized with descriptions of:
- Location
- Quality
- Quantity and severity
- Timing, including onset, duration, and frequency
- The setting in which it occurs
- Factors that have aggravated or relieved the symptom
- Associated manifestations
13. Medications should be noted with:
- Name
- Dose
- Route
- Frequency of use
14. Adult Illness Past History
- Medical
- Surgical
- Obstetric/ gynecological
- Psychiatric
15. Review each of the following conditions and record whether they are present or absent in the family
- Hypertension
- Coronary artery disease
- Elevated cholesterol levels Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible
- Stroke
- Diabetes
- Thyroid or renal disease
- Arthritis
- Tuberculosis
- Asthma or lung disease
- Headache
- Seizure disorders
- Mental illness
- Suicide
- Substance abuse
- Allergies
- Ask about any history of breast, ovarian, colon, or prostate cancer
16. Explain the following terms; -
a) Hemoptysis
- This is coughing up blood
b) Sputum
- This is thick fluid produced in the lungs and the airways leading to the lungs
c) Pleurisy
- This is a condition in which the pleura- a membrane consisting of a layer of tissue that lines the inner side of the chest cavity and a layer of tissue that surrounds the lungs- become inflamed
* It’s also called pleuritis, pleurisy causes sharp chest pain (pleuritis pain) that worsens during breathing
d) Emphysema
- This gradually damages the air sacs (alveoli) in your lungs, making you progressively more short of breath- known as COPD
e) Heart palpitations
- These are the feelings of having rapid, fluttering, or Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible pounding heart. Can be triggered by stress, exercise, medication or rarely, a medical condition
f) Orthopnea
- Difficulty in breathing that occurs when lying down and is relieved upon changing to an upright position
g) Paroxysmal nocturnal dyspnea
- Can be a symptom of heart failure.
- Waking up in the middle of the night with severe shortness of breath
- This may occur with waking up coughing and/or wheezing, having a rapid heartbeat, and a feeling of being suffocated
h) Intermittent claudication
- This is peripheral artery disease, the arteries that supply blood to the legs are narrowed, typically because of atherosclerosis, causing a cluster of pain symptoms called intermittent claudication.
- With proper treatment, new, collateral blood vessels Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible may form, allowing blood to circulate around damaged areas
i) Nocturia
- This is awakening at night to use the bathroom
j) Ureteral Colic
- This is urinary system pain usually from urinary stone
k) Dyspareunia
- This is painful intercourse
l) Gout
- Type of arthritis- it occurs when uric acid builds up in the blood and causes inflammation in the joints
m) Vertigo
- Feeling that you or your surroundings are moving when there is no actual movement
n) Tangential lighting
- Optimal for inspecting structures such a jugular venous pulse, thyroid gland, and the apical impulse of the heart (pulse over the apex of the heart)
o) Supine
- Lying face upward
p) Palpation
- Method of feeling with finger or hands during a physical examination
q) Joint effusion
- Symptom of arthritis- abnormal buildup of joint fluid
17. Which are the four techniques the physical examination Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible relies on:-
- Inspection
- Palpation
- Percussion
- Auscultation
18. Organize your comprehensive or focused examination around three goals
- Maximize the patient’s comfort
- Avoid unnecessary changes in position
- Enhance clinical efficiency
19. Outline the steps when preparing for the physical examination:
- Reflect on your approach to the patient
- Adjust the lighting and the environment
- Check your equipment
- Make the patient comfortable
- Choose the sequence of examination
20. When would you conduct a comprehensive assessment vs focused?
a) Comprehensive
- New patient
- Very sick
- Strengthen pt-ph relationship
- Get baselines for future reference
b) Focused
- Established patient routine visit
- Focused concerns/symptoms
21. What comprises Identifying Data and Source of the History?
a) Identifying data - such as age, gender, occupation, marital status
b) Source of the History - usually pt., may come from family, from referral
- Reliability - varies according to pt. memory, mood etc
22. What comprises the present Illness
- Symptoms (OPQRST)
- Thoughts and feelings about illness (FIFE)
- Medications
- Allergies etc.
23. What comprises of the past history
- Childhood illness
- Adult illness
- Self-care practices
24. What comprises the Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible personal and social History?
- Education
- Family of origin
- Current household
- Personal interests
- Lifestyle
25. Overview of the physical examination - order of it?
- General survey (eg posture, weight)
- Vital signs
- Skin (eg. clammy)
- Head, eyes, ears, nose throat
- Neck
- Back
- Posterior Thorax and Lungs
- Breasts, Axillae and Epitrochlear nodes
- Anterior Thorax and Lungs
- Cardiovascular System
- Abdomen
- Lower Extremities
- Nervous System
26. When asking about present illness is it appropriate to ask about medications, allergies and habits?
- Yes, may be related to the present illness
27. Is it okay to ask about culture and family in the Professional assignment writing help "Bates, Chapter 1 – Physical Examination and History Taking" Meet the team that makes it all possible personal and social history?
- Yes, culture plays an important role in health seeking behavior and defining illness